PANCREAS Dr Jamila Elmedany & Dr Saeed Vohra

OBJECTIVES By the end of this lecture the student should be able to : Describe the anatomical view of the pancreas regarding ; location, parts relations, ducts Arterial supply & Venous drainage Describe the nerve supply and lymph drainage 2

PANCREAS It is an elongated soft pinkish structure (60-100) gram in weight & (6-10) inch in length It is Lobulated? Because it is surrounded by a fibrous tissue capsule from which septa pass into the gland and divide it into lobes. The lobes are divided into lobules. It is an elongated soft pinkish structure (60-100) gram in weight & (6-10) inch in length It is Lobulated? Because it is surrounded by a fibrous tissue capsule from which septa pass into the gland and divide it into lobes. The lobes are divided into lobules. 3

LOCATION It is a Retro-Peritoneal structure. It lies on the posterior abdominal wall in the: Epigastrium & Left upper quadrant of the abdomen. It extends in a transverse oblique direction at the transpyloric plane (1 st lumbar vertebral) from the concavity of the duodenum on the right to the spleen on the left. It is a Retro-Peritoneal structure. It lies on the posterior abdominal wall in the: Epigastrium & Left upper quadrant of the abdomen. It extends in a transverse oblique direction at the transpyloric plane (1 st lumbar vertebral) from the concavity of the duodenum on the right to the spleen on the left.

PARTS 5

Head of Pancreas It is disc shaped Lies within the concavity of the duodenum Related to the 2 nd and 3 rd portions of the duodenum. On the right, it emerges into the neck. On the left, it Includes Uncinate Process ( an extension of the lower part of the head behind the superior mesenteric vessels) It is disc shaped Lies within the concavity of the duodenum Related to the 2 nd and 3 rd portions of the duodenum. On the right, it emerges into the neck. On the left, it Includes Uncinate Process ( an extension of the lower part of the head behind the superior mesenteric vessels)

Structures Posterior to the Head: (1) Bile Duct runs downwards and may be embedded in it.? (2) IVC runs upwards. Structures Posterior to the Head: (1) Bile Duct runs downwards and may be embedded in it.? (2) IVC runs upwards. 7

Neck of Pancreas It is the constricted portion connecting the head & body of pancreas It lies in front of: Aorta Origin of Superior Mesenteric artery the confluence of the Portal Vein Its antero-superior surface supports the pylorus of the stomach The superior mesenteric vessels emerge from its inferior border It is the constricted portion connecting the head & body of pancreas It lies in front of: Aorta Origin of Superior Mesenteric artery the confluence of the Portal Vein Its antero-superior surface supports the pylorus of the stomach The superior mesenteric vessels emerge from its inferior border

Body of Pancreas 9

Tail of Pancreas A narrow, short segment lies at the level of the 12 th thoracic vertebra Ends within the splenic hilum Lies in the Splenicorenal ligament Anteriorly, related to: splenic flexure of colon May be injured during Splenectomy A narrow, short segment lies at the level of the 12 th thoracic vertebra Ends within the splenic hilum Lies in the Splenicorenal ligament Anteriorly, related to: splenic flexure of colon May be injured during Splenectomy

RELATIONS OF PANCREAS Anterior to (body & tail): Stomach separated from by lesser sac Transverse colon & transverse mesocolon Anterior to (body & tail): Stomach separated from by lesser sac Transverse colon & transverse mesocolon 11

Posterior to (body & tail) : Left Psoas muscle Left Adrenal gland Left Renal vessels Upper 1/3 rd of Left kidney Hilum of the spleen. Posterior to (body & tail) : Left Psoas muscle Left Adrenal gland Left Renal vessels Upper 1/3 rd of Left kidney Hilum of the spleen.

FUNCTIONS Exocrine and Endocrine The Exocrine portion: Small ducts arise from the lobules and enter the main pancreatic duct (it begins in the tail), and passes through the body and head where it meets the bile duct. The Endocrine portion: (Islets of Langerhans) produce insulin & glucagon. Exocrine and Endocrine The Exocrine portion: Small ducts arise from the lobules and enter the main pancreatic duct (it begins in the tail), and passes through the body and head where it meets the bile duct. The Endocrine portion: (Islets of Langerhans) produce insulin & glucagon. 13

Pancreatic DUCTS Main P duct : Joins common bile duct & they open into a small hepatopancreatic ampulla in the duodenal wall (Ampulla of Vater). The ampulla opens into the lumen of the duodenum through (Major Duodenal Papilla). Main P duct : Joins common bile duct & they open into a small hepatopancreatic ampulla in the duodenal wall (Ampulla of Vater). The ampulla opens into the lumen of the duodenum through (Major Duodenal Papilla).

Accessory P duct (of Santorini) Drains superior portion of the head It empties separately into 2 nd portion of duodenum at (minor duodenal papilla) Accessory P duct (of Santorini) Drains superior portion of the head It empties separately into 2 nd portion of duodenum at (minor duodenal papilla) 15

ARTERIAL SUPPLY R gastric Hepatic

VENOUS DRAINAGE Anterior and posterior arcades drain head and the body Splenic vein drains the body and tail Ultimately, end into Portal Vein Anterior and posterior arcades drain head and the body Splenic vein drains the body and tail Ultimately, end into Portal Vein

LYMPHATIC DRAINAGE 18

NERVE SUPPLY Sympathetic from the splanchnic nerves, they have a predominantly inhibitory effect Parasympathetic from the Vagus, they stimulate both exocrine and endocrine secretions Sympathetic from the splanchnic nerves, they have a predominantly inhibitory effect Parasympathetic from the Vagus, they stimulate both exocrine and endocrine secretions

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